tbuckley/cabot-search huggingface dataset:
Abstract 13502: Prognostic Significance of Non-Infarct-Related Coronary Artery Chronic Total Occlusion in Patients Presenting With Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Muhammad Junaid Ahsan, Noman Lateef, Soban Ahmad, azka latif, Muhammad Zoraiz Ahsan, kainat faizi, Mohsin M Mirza, Mark Tannenbaum, Sivakumar Ardhanari, Andrew M Goldsweig
Journal: Circulation (2022)

Introduction: In patients with acute myocardial infraction (AMI), multivessel coronary artery disease (CAD) is associated with worse prognosis than single-vessel CAD. Several observational studies have reported worse clinical outcomes in AMI patients with non-infarct-related artery chronic total occlusion (n-IRA CTO). We performed a systematic review and meta-analysis to evaluate the prognostic significance of n-IRA CTO in patients with AMI. Methods: Systematic review was performed querying PubMed, Google Scholar, Cochrane and clinicaltrials.gov from Inception through May 2022. Studies comparing AMI patients with and without n-IRA CTO were included. Outcomes included in-hospital, 30-day and long-term mortality, cardiac mortality, major adverse cardiovascular events (MACE), and major bleeding. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. Results: Five prospective, eight retrospective and 3 subgroup analyses of randomized control trials (RCTs) (n-IRA CTO n=2,521, no CTO n=18,397) were identified. Presence of n-IRA CTO was associated with higher in-hospital (RR 2.86, 95% CI 1.77-4.62, p&lt;0.0001, Figure A), 30-day (RR 2.54, 95% CI 1.66-3.89, p&lt;0.00001, B) and long-term mortality (RR 2.32, 95% CI 1.81-2.99, p&lt;0.00001, C), as well as increased risk for cardiac mortality (RR 2.24, 95% CI 1.79-2.81, p&lt;0.0001, D), MACE (RR 1.51, 95% CI 1.32-1.74, p&lt;0.0001, E), and major bleeding (RR 1.99, 1.16-3.41, p=0.01, F) when compared to AMI patients without n-IRA CTO. Conclusions: In AMI patients, the presence of n-IRA CTO is associated with increased mortality and morbidity. Future studies should evaluate whether intensive monitoring and specialized care can improve outcomes in these patients.
Abstract 13369: Takotsubo Cardiomyopathy Following Electroconvulsive Therapy
Authors: Andrew A Girard, James Hammock, Christopher Ives, Roberto Camacho
Journal: Circulation (2022)

Case Presentation: A 71-year-old woman presented to our institution for treatment-refractory depression requiring electroconvulsive therapy (ECT). She underwent a transthoracic echocardiogram (TTE) during a pre-ECT evaluation, which demonstrated no regional wall motion abnormalities and a left ventricular ejection fraction (LVEF) of 60 - 65%. The patient subsequently underwent ECT. During the procedure, sinus tachycardia with associated ST-segment changes were noted on telemetry. Esmolol was administered with subsequent improvement in her tachycardia, however ST-segment changes persisted. A twelve-lead electrocardiogram was obtained and was notable for new T-wave inversions in leads V1-V4 and Q-waves in leads III and aVF. However, STEMI criteria was not met. A TTE obtained shortly after her ECT demonstrated ballooning of the LV apex and an LVEF of 35%, consistent with takotsubo cardiomyopathy. Laboratory evaluation was notable for a high sensitivity troponin peak of 130 ng/L and a brain natriuretic peptide level of 746 pg/mL. Cardiac catheterization was not performed as the patient had a negative stress test prior to admission. The patient’s symptoms improved over the next two days, and she was discharged with close outpatient follow-up. Discussion: Takotsubo cardiomyopathy occurs following physical or psychological stress. Greater than half of patients with takotsubo cardiomyopathy have neurologic or psychiatric disorders. Takotsubo cardiomyopathy is an increasingly recognized serious complication of ECT and can be seen in post-menopausal women with depression. The introduction of beta blocker therapy has been used to prevent recurrent episodes of post-ECT takotsubo cardiomyopathy. Despite this, there are reports of post-ECT takotsubo cardiomyopathy in patients on chronic beta blocker therapy. Thus, the risks and benefits of proceeding with additional ECT treatments must be weighed after an initial episode of takotsubo cardiomyopathy.
Abstract 13559: Altered Nucleotide Biosynthesis is a Prominent Metabolic Feature of Cardiac and Liver Aging
Authors: Zimple Kurlawala, Kyle Fulghum, Teresa Cassel, Kenneth R Brittian, Jing-Juan Zheng, Ernesto Pena Calderin, Teresa W Fan, Pawel Lorkiewicz, Jason L Hellmann, Matthew A Nystoriak, Bradford G Hill
Journal: Circulation (2022)

Introduction: The heart is particularly vulnerable to age-related dysfunction, with left ventricular hypertrophy and diastolic dysfunction developing in late life. In this study, we used deep network tracing to elucidate the effects of aging on glucose metabolism in the heart and peripheral tissues of a mouse model of late-life cardiac dysfunction. Hypothesis: Aging processes in the heart are mediated through altered nucleotide metabolism. Methods: Young (12–16 wk, n =6) and aged (80–84 wk, n =6) male C57BL/6J mice were subjected to treadmill exercise capacity tests and echocardiographic measurements. To delineate the effects of age on in vivo glucose metabolism, we delivered 13 C 6 -glucose to mice via a liquid diet and analyzed 13 C enrichment and the relative abundance of metabolites in the heart, liver, and skeletal muscle by ion exchange chromatography-mass spectrometry. Results: Compared with young mice, aged mice had lower exercise capacity (257.3 vs. 394.2 meters distance, p =0.0002 and 0.9 vs. 1.4 kg/m work, p =0.07), which was associated with a 1.3–fold increase in left ventricular mass ( p =0.0006) and longer isovolumetric relaxation time (IVRT: 12.3 vs. 14.1 ms, p =0.03). Although no significant differences in 13 C enrichment were found for metabolites in the glycolysis and tricarboxylic acid cycle pathways, we found 1.2- to 1.5-fold difference in 13 C enrichment ( p &lt;0.05) in purine (AMP, ADP, ATP and GMP, GDP, GTP) and pyrimidine (UMP, UDP, UTP, uridine, orotidine) metabolites. Additionally, aged hearts had 2.4-fold higher levels of the pyrimidine precursor N-carbamoyl L-aspartate. Similar changes were detected in the pyrimidine metabolite pool in aged liver, but not skeletal muscle. Conclusions: These data indicate that altered nucleotide biosynthesis is a prominent metabolic feature of cardiac and liver aging and could provide novel insights into age-related decrements in cardiovascular health.
Abstract 12760: Microvascular Endothelial Dysfunction in Postural Orthostatic Tachycardia Syndrome Associated With Post-Acute Sequelae of COVID-19
Authors: Ali Mahdi, Ulrika Reistam, Jannike Nickander, Artur Fedorowski, Liyew Desta, Malin Nygren-Bonnier, Michael Runold, Judith Bruchfeld, John Pernow, Marcus Stahlberg
Journal: Circulation (2022)

Introduction: Post-acute sequelae of COVID-19 (PASC) is a novel clinical syndrome. We have previously reported that PASC patients can develop postural orthostatic tachycardia syndrome (POTS) and that COVID-19 induce microvascular endothelial dysfunction in acutely ill, hospitalized patients, that persist up to four months post discharge. Whether microvascular endothelial dysfunction contributes to POTS pathophysiology in PASC remains unclear. Hypothesis: Patients with PACS combined with POTS have impaired microvascular endothelial function. Methods: PASC patients (n=44) with mild SARS-CoV-2 infection (not hospitalized) were recruited from the post-COVID multidisciplinary clinic at Karolinska University Hospital. PASC diagnosis was based on the WHO PASC criteria. POTS was diagnosed in 21 patients (PASC + POTS) while 23 had a negative head-up tilt test (PASC - POTS). Age- and gender-matched healthy subjects (n=15) served as controls. Microvascular endothelial function was quantified as reactive hyperemia index (RHI) determined from the changes in pulse amplitude tonometry before and after a 5 min episode of arterial occlusion. Stress-perfusion cardiac magnetic resonance imaging (cMRI) with adenosine was performed in a subset of patients. Results: Mean age was 42±11 years and 95 % were women among PACS patients. Time from COVID-19 symptom onset to study inclusion was 18±3 months. RHI was significantly lower in PASC + POTS than in healthy controls and PASC - POTS (Figure 1). The prevalence of cardiac microvascular dysfunction on cMRI did not differ between the PASC groups (8% in PASC + POTS vs. 13% in PASC - POTS, p=1.00). All subjects with microvascular dysfunction on cMRI except one had a RHI below the cutoff (1.67) indicating microvascular dysfunction. Conclusions: Microvascular endothelial dysfunction is common in patients with PACS-associated POTS and may cause stress-induced myocardial ischemia up to 18 months after a mild primary infection.
Abstract 12895: Blood Pressure Outcomes After 9 Months With Remote Patient Monitoring For Hypertension in Primary Care: A Prospective Cohort Study in Electronic Health Records Using Propensity Score Matching
Authors: Stephen D Persell, Lucia Petito, Ji Young Lee, Yaw Peprah, Lauren Anthony, Jim Li, Hironori Sato
Journal: Circulation (2022)

Introduction: Remote patient monitoring (RPM) for blood pressure (BP) in primary care may support hypertension control. Hypothesis: Among Medicare patients enrolled from six pilot primary care clinics, those prescribed RPM would have better BP control (BP &lt;140/90 mm Hg), and lower office SBP at 3, 6 and 9 months compared with matched controls. Methods: This was a pragmatic observational study. Patients were included if they belonged to any of six primary care practices that were in pilot studies of the Omron VitalSight TM RPM system which enabled transmission of BP and pulse from a BP monitor into the electronic health record without manual entry. We used 1:4 propensity score matching to identify contemporary matches for 288 RPM-prescribed patients from the same clinics, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare use characteristics. Outcomes included controlling high blood pressure (most recent primary care office or RPM BP &lt;140/90 mm Hg), most recent primary care office SBP, and most recent primary care or RPM SBP, and were assessed after 3, 6, and 9 months. Results: Baseline characteristics of the 288 RPM patients and 1152 controls were similar. The mean ages (SD) were 73.6 (7.4) and 73.8 (7.9) years, respectively. Corresponding mean (SD) SBPs were 142.7 (19.5) and 141.2 (18.7) mm Hg. Controlling high blood pressure was greater in the RPM-prescribed cohort than in matched controls at 3, 6 and 9 months (Table). Mean of last office SBPs did not differ. Means of most recent SBP that included remote values were lower for the RPM-prescribed cohort at 3, 6 and 9 months. Conclusions: BP control and mean of last office or remote SBP diverged quickly and were partially sustained at 9 months. As mean office SBPs did not differ, additional evaluation is needed to assess the degree to which observed differences were due to greater declines in BP overall among RPM patients vs. differences between measured home and office blood pressures.
Abstract 13622: Effect of Dapagliflozin and Saxagliptin Combination on CD34+ve Endothelial Progenitor Cells (EPCs) in Type 2 Diabetes Subjects
Authors: Seshagiri R Nandula, Adrian Elzarki, Sabyasachi Sen
Journal: Circulation (2022)

Introduction: We examined the effect of Dapagliflozin (Dapa) and Dapagliflozin-Saxagliptin combination (Combo) on EPCs in Type-2-Diabetes (T2DM) subjects as a cellular cardiovascular biomarker. Both Dapa (a SGLT2 receptor inhibitor) and Saxagliptin (a DPP4 enzyme inhibitor) are T2DM medications, but the combination has not been evaluated for cardiovascular outcomes, using stem cells. Hypothesis: We hypothesized that Dapa will improve EPC number and function compared to placebo and Combo may have additional positive effects. Methods: In this pilot study, 15 subjects were enrolled in 16 weeks, double-blind, randomized placebo matched trial, with 3 arms: 10mg Dapa + Saxa placebo (n=4), 10 mg Dapa + 5 mg Saxa (n=5) Combo, And Dapa placebo + Saxa placebo (n=6), Placebo groups. T2DM (30-70 years) and HbA1c of 7-10%, were included. HbA1C between 7 to 8 was maintained. Peripheral blood derived CD34+ EPC number, migratory function, mRNA gene expression along with arterial stiffness, biochemistry, resting energy expenditure, and body composition were measured. Data were collected at weeks 0, 8, and 16. A mixed model regression analysis was done with a p-value &lt;0.05 considered significant. Results: A significant decreased glucose (p=0.0317) and HbA1c (p=0.0357) levels were noted in Combo group compared to Dapa and more so compared to Placebo. hsCRP levels (P=0.0317)) are significantly reduced in both Dapa and Combo (to a similar extent) vs Placebo. The LDL/HDL ratio is significantly reduced (p=0.05) in combination group as compared to either Dapa alone or Placebo group. Leptin levels decreased significantly in both Dapa alone (p=0.035) and Combo group(p=0.015) , to a similar extent vs Placebo. EPC migration improved significantly in both Dapa alone (p=0.05) and Combo group (p=0.05) , to a similar extent, vs Placebo. Both Serum IL-6 levels and IL6-mRNA expression on EPCs showed significant reduction in both Dapa and Combo (to a similar extent) vs Placebo. Conclusions: Our study indicates that several parameters showed significant differences of Dapa and Combo when compared to placebo. However, other than glycemic control the Combo did not offer any further benefit over Dapa alone as far as inflammatory markers or stem cell number or migration properties were concerned.
Abstract 13669: Ascending Aortic Augmentation Pressure Does Not Decrease During Exercise in HFpEF: Implications for SV Reserve Impairment
Authors: Denis J Wakeham, Joetsaroop S Bagga, Seamus B Hughes, Bryce N Balmain, Andrew R Tomlinson, Tony G Babb, James P Macnamara, Christopher M Hearon, Benjamin D Levine, Satyam Sarma
Journal: Circulation (2022)

Aortic augmentation pressure (aAP; difference between first [aP1] and second [aP2] peaks of the aortic pressure waveform) decreases during exercise in young healthy individuals, lowering mid-late systolic afterload, an important determinant of cardiac work and stroke volume (SV). In patients with heart failure and preserved ejection fraction (HFpEF), SV responses to exercise (i.e. SV reserve) are often abnormal (≤ 50%). A lack of fall in aAP during exercise in HFpEF could contribute to impairments in SV reserve. Therefore, we studied 15 HFpEF patients (age, 71 ± 6 years; 10 women; BMI 39.2 ± 6.2 kg/m 2 ) in the seated upright position. During rest and six-minutes of cycling at 20 Watts, we recorded beat-by-beat radial arterial blood pressure and estimated ascending aortic blood pressure waveforms in real-time via a generalized inverse transfer function (SphygmoCor). SV was calculated from cardiac output (Qc, acetylene rebreathe) and heart rate (ECG), with total peripheral resistance (TPR) calculated as the quotient of radial MAP and Qc. HR (Rest: 75 ± 14 vs 20W: 93 ± 12 bpm, P &lt; 0.0001), SV (Rest: 61 ± 17 vs 20W: 84 ± 19 ml, P = 0.0003) and Qc (Rest: 4.5 ± 1.0 vs 20W: 7.7 ± 1.6 L/min, P &lt; 0.0001) increased from rest to 20 Watts, whilst TPR decreased (Rest: 21.3 ± 4.4 vs 20W: 14.0 ± 3.8 mmHg/L/min, P &lt; 0.0001); SV reserve was 43 ± 33 %. Aortic diastolic pressure did not change (Rest: 70 ± 12 vs 20W: 76 ± 15 mmHg, P = 0.0976), whereas aP1 (Rest: 112 ± 18 vs 20W: 130 ± 20 ml, P = 0.0002) and aP2 (Rest: 123 ± 26 vs 20W: 142 ± 25 ml, P = 0.0021) increased during exercise (Figure). Notably, aAP was not different between rest and exercise (Rest: 11 ± 11 vs 20W12 ± 11 mmHg, P = 0.4969). Therefore, the contribution of aAP to mid-late systolic afterload is unchanged during exercise in HFpEF, unlike in young healthy adults. Unchanged aAP may be a mechanism of high mid-late systolic afterload during exercise in HFpEF, which could contribute to impairments in SV reserve related to reduced ventricular contractile reserve.
Abstract 13745: Electronic Cigarette-Derived Aerosols Induce Endothelial Dysfunction: Role of Aldehydes and Transient Receptor Potential Ankyrin-1 in Mice
Authors: Lexiao Jin, Andre Richardson, Laura Fryar, Pawel Lorkiewicz, Daniel Riggs, Sanjay Srivastava, Aruni Bhatnagar, Daniel J Conklin
Journal: Circulation (2022)

Introduction: Electronic cigarettes (e-cigs) threaten to reverse the decline in rates of nicotine dependence and smoking. While some believe that e-cigarettes are less harmful than combustible cigarettes, e-cig use is associated with respiratory symptoms (cough, wheeze) and endothelial dysfunction (ED) indicating a potential to increase the risk of cardiovascular disease (CVD) with chronic use. ED is sine qua non of multiple CVD, yet the mechanism of e-cig-induced ED is unknown. Hypothesis: E-cigs generate levels of irritants that activate the Transient Receptor Potential Ankyrin-1 (TRPA1) to trigger nocifensive reflexes and induce ED in mice. Methods: Wild type (WT) and TRPA1-null C57BL/6J male and female mice were exposed to: filtered air (control), aerosols of JUUL e-cig liquid, e-cig solvents without nicotine (propylene glycol:glycerin, PG:G), or irritant gases alone (acrolein, formaldehyde). Urinary levels of nicotine and aldehyde metabolites were measured by UPLC-MS/MS. During acute exposures, respiratory irritant responses were monitored by radiotelemetry. Following short-term exposure (4d), aortic endothelial function, blood/plasma markers of organ toxicity, and platelet activation were measured. Results: Exposure of WT mice to e-cig aerosols increased urine levels of the acrolein, but not formaldehyde, metabolite (3HPMA), to that of exposures to 1 ppm acrolein alone. In WT mice, exposure to either PG:G (30:70), formaldehyde (5 ppm), or acrolein (1 ppm) induced respiratory braking. In female WT mice (n=5-18), exposure to PG:G (-61.8±4.2 % ACh relaxation) and formaldehyde (–56.3 ± 4.5 %) but not acrolein (-80.0±3.2 %) induced ED vs control group (-77.8±1.5 %). In female TRPA1-null mice (n=5-14), neither PG:G (-77.6±3.6 %), formaldehyde (-85.9±7.8 %) nor acrolein (-86.6±2.8 %) exposure induced ED vs control (-81.3±5.4 %). Acrolein exposure enhanced aortic sensitivity to an NO donor similarly in female WT and TRPA1-null mice. Conclusions: Formaldehyde and acrolein generated from the PG:G in e-cigs provoked pulmonary irritant reflexes, and formaldehyde exposure alone induced ED in female mice. Irritant aldehydes in e-cig-derived aerosols activate the TRPA1 receptor to promote ED that could increase CVD risk.
Abstract 12873: Arrhythmogenic and Ischemic Cardiopathy Mimics Covid-19 Myocarditis
Authors: Olga Shakhmatova, Tatyana Balakhonova, Nikolay Mironov, Maxim Makeev, Zoya Blankova, Ekaterina Butorova, Vsevolod Mironov, Elizaveta P Panchenko
Journal: Circulation (2022)

A 63-year-old man with a history of hypertension, hyperlipidemia and severe COVID-19 3 months earlier presented with NYHA class III-IV heart failure (HF) and intermittent claudication. Three months before, patient noted increasing dyspnea. SARS-CoV2 was verified. CT scan showed pneumonia; the severity of disease required dexamethasone and tocilizumab. Atrial fibrillation (AF) and LV EF 30% were first detected. CT scan disclosed left atrial appendage (LAA) thrombosis. Despite anticoagulants, 3 weeks later the patient developed lower limbs ischemia. Ultrasound and CT scan showed multiple thrombosis in the abdominal aorta and lower limbs arteries (Figure A). Surgery for limb ischemia was not performed due to a further decrease of LV EF to 18%. At that point, diagnosis was SARSCoV2-induced myocarditis. Нe visited our hospital for second opinion. ECG showed AF with mean heart rate (HR) of 158/min (B). Careful history collection suggested a longer AF duration which was missed and untreated due to lockdown. CRP, troponin were normal. NT-proBNP was 9326 pg/ml. After strict rate control was achieved, LV EF became 23%. Cardiac MRI with delayed gadolinium contrast revealed no fibrosis or active myocarditis (C). Angiography showed stenosis &gt;70% of the left anterior descending artery (D). After PCI, LV EF became 27%. The patient was discharged on guideline-recommended optimal medical therapy. Three months later LV EF became 30%, six months later - 47%. Thrombus in LAA was dissolved. Pulmonary vein isolation and cardioversion were performed. One week later LV EF was 60%. Currently, the patient has stable sinus rhythm and no signs of HF for &gt; 6 months. Thus, COVID-19 could contribute to the progression of atherosclerosis, modify the substrate and aggravate the severity of AF, but it was not the only cause of a serious illness in the patient. COVID-19 also had an indirect negative impact - delay the detection of cardiac pathology and cause its underdiagnosis under the guise of "post-COVID".
Abstract 13230: Prevalence, Trends, and Outcomes of Cardiovascular Diseases in Pregnant Patients in the United States: 2010 to 2019
Authors: Monil Majmundar, Rajkumar P Doshi, Harshvardhan Zala, Kunal N Patel, Ashish Kumar, Ankur Kalra
Journal: Circulation (2022)

Introduction: Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVD) in pregnant patients are limited. Hypothesis: We aimed to analyze the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the United States (U.S.). Methods: This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to December 31, 2019. Pregnancy-associated hospitalizations were identified, and patients with missing information on the length of stay (LOS) and mortality were excluded. Main outcomes were prevalence and trend of CVD burden in pregnant patients. Results: 39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.25%) and 34,802,180 without CVD (88.75%). The annual CVD burden increased from 9.49 % in 2010 to 15.54 % in 2019 (p&lt;0.001). Hypertensive disorder of pregnancy (1069/10,000) was the most common, and aortic dissection (0.1/10,000) was the least common CVD. Trends of all CVD subtypes increased; however, the trend of valvular heart disease decreased. In-hospital mortality was 8.2/10,00 in CVD but its trend decreased from 8.9/10,000 in 2010 to 7.4/10,000 in 2019 (p&lt;0.001). CVD was associated with higher odds of mortality compared with non-CVD patients (odds ratio (OR): 32.7, 95% CI 28.8-37.1, p&lt;0.001). CVD was associated with higher 6-week postpartum readmission (OR: 1.97, 95% CI: 1.95-1.99), myocardial infarction (OR: 3.04, 95% CI: 2.57-3.59), and stroke (OR: 2.66, 95% CI: 2.41-2.94) (p&lt;0.001 for all). Conclusions: Overall CVD burden is high among pregnant patients with a significant uptrend of CVDs from 2010 to 2019 in the U.S. CVD burden was associated with higher in-hospital mortality, and 6-week postpartum all-cause readmission, myocardial infarction, and stroke. However, mortality among CVD patients decreased from 2010 to 2019 in the U.S.